September 28, 2015

Potential for Government Shutdown Stirring Concern Ahead of ICD-10 Implementation

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The potential for a perfect storm of ICD-10 being implemented and the federal government shutting down on the same day – Oct. 1, less than a week away – is stirring major concerns among providers nationwide.

The majority of questions fielded by Centers for Medicare & Medicaid Services (CMS) Principal Deputy Administrator Patrick H. Conway and CMS ICD-10 Ombudsman William Rogers during a Thursday morning press conference call centered on what such a shutdown could mean for providers scrambling to address issues associated with the implementation.

 

“Obviously, the administration’s goal is to continue with the government fully operational,” Conway said. “(But) in the event of a shutdown, we will continue – and I want to be clear on this – to take claims, and we will continue to implement the ICD-10 transition.”

For weeks, congressional Republicans have flirted with the notion of fomenting a shutdown in an effort to snuff out federal funding for Planned Parenthood, the embattled nonprofit organization that provides reproductive health services for women nationwide. President Barack Obama has pledged to veto any federal funding bill that edits out the roughly half a billion dollars Planned Parenthood annually receives, however, setting the stage for a showdown next week.

The last government shutdown occurred in 2013, when federal workers were kept from their duties for more than two weeks in the wake of an ultimately unsuccessful Republican effort to quash provisions of the Patient Protection and Affordable Care Act.

“We just don’t know, honestly,” Rogers said when asked precisely how a shutdown might affect CMS operations. “We have more experience than we’d like to have, but we don’t have a lot of experience with this, and … there are different legal issues that have to be considered about what are emergency operations and what aren’t.”

“People who aren’t in this room are deciding what we can legally do and what we can’t do in case of a shutdown in terms of staffing at CMS,” he added.

Yet Rogers added that Medicare Administrative Contractors (MACs) will remain active during the length of any potential shutdown, with claims continuing to be accepted and paid.

“And we’re sure of that,” Rogers said.

A possible government shutdown notwithstanding, both CMS representatives expressed optimism that the nation’s healthcare infrastructure is sufficiently prepared for the fundamental shift ICD-10 represents.

“It’s a change that will help doctors and other healthcare providers to better define a patient’s clinical status and treat complex medical conditions, improve coordination of a patient’s care across providers, and support innovative payment methods that drive quality of care,” Conway said. “Medicare beneficiaries should know this, and this is critical: after October 1st, they’ll be able to get the same services as before; their coverage for items will not change. This should have no impact on their doctor, lab, X-ray, or hospital visit – they will still receive the care they need, when they need it.”

The specific effects of the ICD-10 implementation won’t be immediately apparent, CMS officials warned, but once clarity presents itself, the results will be disseminated.

“We will monitor in as close to real time as possible as we implement the ICD-10 transition,” Conway said. “After the (completion of one billing cycle), we’ll start to have a more full picture on the transition, and we would of course communicate transparently with our various stakeholders about how the transition has progressed.”

Rogers additionally pledged that his office’s services will remain available to providers – shutdown or not.

“I see ICD-10 as a source of great anxiety to the clinicians out there, and I think as most of the specialty societies know and a lot of doctors and other clinicians out there know, I’m very responsive, and I feel very strongly that we should be the best possible business partner that we can,” he said. “I’m thrilled to be serving in this role as we get through this transition, and we have obviously proven that our claims processing system is going to be able to accept properly coded claims without any problem, and they’ll be paid.”

 

 

Mark Spivey

Mark Spivey is a national correspondent for ICDmonitor.com who has been writing on numerous topics facing the nation’s healthcare system (and federal oversight of it) for five years. 

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